Do you have any previous conditions?
In the past 5 years, have you been treated or prescribed medication for any of the following conditions?
I have no medical conditions
Alcohol or Substance Abuse
Alzheimer's disease or Dimentia
Any condition requiring use of oxygen
Congestive Heart Failure(CHF)
Heart Attack or Stroke
HIV or AIDS
Internal cancer, melanoma or leukemia
Kidney disease requiring dialysis
Lou Gehrig's Disease(ALS)
Neuromuscular(Parkinson's, CP, MS)
*Choose all that apply.